AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Ugwuanyi Ugochukwu Charles, Neurosurgery unit, National Hospital Abuja and Wellington Neurosurgery Center Abuja.
Citation: Ugwuanyi U.C., Anigbo A.A., Nwaribe E.E., Salawu M.M., Jibrin P.G., Arua C.S., Okpata C.I. and Ayogu OM. (2021) Stereotactic Biopsy of Brainstem Lesion in Children: Techniques, Efficacy and Safety: Case Review of Single Institutional Experience. J Surgical Case Reports and Images, 4(2): DOI: 10.31579/2690-1897/061
Copyright: © 2021 Ugwuanyi Ugochukwu Charles. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 01 February 2021 | Accepted: 11 March 2021 | Published: 22 March 2021
Keywords: pediatric brain stem lesions, stereotactic biopsy, diagnostic yield
Introduction: Stereotactic biopsy of brain stem lesions in children evolved from a controversial background but the current trend seems towards a safe procedure that will yield diagnostic accuracy to guide targeted and individualized treatments.
Aims and Objectives: To confirm safety, accuracy and usefulness of biopsy of brain stem lesions using our institutional experience on two index cases that underwent stereotactic procedures.
Methodology: A review of two case reports were conducted to expose diagnostic success and procedure-related highpoints.
Results: In both cases presented the procedure was uneventful, yielded the desired diagnostic tissue and there were no procedure related complications.
Conclusion: Stereotactic biopsy of pediatric brain stem lesion is safe. Tissue sampling was accurate in both cases and served as a prerequisite more targeted oncology referral and potentially individualized treatment.
With the entrance and perfection MRI sequences in diagnostic neuroimaging since the early 1980s, there was a near complete detachment from diagnostic biopsy procedures for Brain stem lesions. It was then suggested that MRI was sufficient to establish a diagnosis upon which judgement on adjuvant treatments could be anchored. Oncologists were dissuaded from insisting on tissue diagnosis before deploying cancer treatment modalities including chemotherapy and radiotherapy. They were rather persuaded to rely on evidence derivable from MRI. This management philosophy was further buttressed by the fact that biopsy or indeed any previous surgical strategies did not influence convincingly the outcome of not only brainstem lesions but also most pediatric brain tumors. It was also argued that the morbidity and mortality does not match the potential benefits. The assumption was that all brain stem lesion were tumors especially gliomas and should be treated as such. This position was corroborated in 1993 by Albright et al in their report on the results of the Children’s Cancer Group DIPG study and concluded that MRI was adequate in making the diagnosis, since tissue sampling did not alter the treatment or impact outcome [1].
There is a resurgence in current thinking that Brain stem lesions could and should be biopsied. Since 2015, the evidence derived from Hamish et al [2]. formed the basis for a paradigm shift back to the traditional clinical methods of diagnostic tissue guided adjuvant treatments. The attendant complications of diagnostic biopsy procedures were largely eliminated by the adoption of stereotactic biopsy procedures. Furthermore, the safety, efficacy and high diagnostic yield made it worthwhile. A sound understanding of first neuroanatomy and second the principles of neuronavigation is key to success. A trans cerebellar route, image-guidance through the cerebellar peduncles provides a safe corridor to lesions on the pons and indeed other parts of the brain stem. This trajectory must and is usually below the transverse sinus. Stereotactic biopsy is either frame based such as the Leksell system or Frameless such as the Brain Lab, Stealth Navigation system etc. It is also instructive to note that the successes recorded in stereotactic biopsy have been extended to the application of Robots and Cobots to enhance degree of precision. For this series of two cases reported below, we have deployed the Medtronic Stealth Neuro-navigation system. The technical nuances, safety, complications, and diagnostic yield form the experiences we hereby share. The aim of this report is therefore to present the safety, diagnostic success, and procedure related complications of stereotactic biopsy from experience gathered from two cases of pediatric brain stem lesions.
Ethical clearance was sought for and obtained from the institution involved in this study namely the Wellington Neurosurgical Centre Abuja. Following a clinical and radiological suspicion of brain stem lesion as detailed by the case reports below, council and consent was obtained to proceed with a diagnostic stereotactic biopsy. Frameless Stealth guided procedures using the Medtronic USA neuronavigation Treatment Guidance system was used for the two cases.
It is important to understand the basic principles of this procedure in order to conduct it in an orchestrated manner. It starts with establishment of physical coordinates by application of about ten sticky fiducial markers or surface landmarks at designated points on the head of the patient on the day of the surgery. This is to reduce the chances of losing the sticky fiducials which has a tendency to fall off the longer it stays. Then the patient is taken to the CT suite where a contrasted CT Brain is obtained in axial slices only to establish imaging coordinates. Patient is then transferred to the operating theatre for pre-induction anesthesia checks and insertion of mandatory monitors. At about same time the stealth CT images already loaded on a CD is installed on the Stealth Machine and the imaging coordinates appropriately registered. The next stage which is probably the most important and thus considered the backbone of stereotactic procedures is co-registration of the pre-operatively acquired imaging coordinates with the physical coordinates which is the patient’s head. For this to happen the patient who is already anesthetized will have the head fixed on Mayfield pins and positioned appropriate to the intended procedure. In both cases presented here, a prone position was adopted with head and neck flexed in military flexion to expose the nape of the neck. The entry point for the planned trans cerebellar approach is sufficiently exposed. The cranial reference frame with the optical reflecting balls is attached to the Mayfield articulating system and positioned close to the head but on the contralateral side of the lesion. A special optical tracking system is used to perform the actual co- registration which basically involves the point-to-point synchronization of the Fiducials on the patients head with the exact designated points on the registered imaging coordinates on the stealth machine. Following a successful co-registration, the process of navigation and stereotactic surgery commences with surgical planning. This involves the application of sound neuroanatomic knowledge in combination with Stealth computer guidance to define safe entry points, trajectory path and exact distance to surgical targets as shown on pre-op scans (CT, MRI). Then, the site is prepared with standard sterile precautions and draped accordingly. Stealth guided mini skin incision is made usually on the suboccipital region below the transverse sinus. Then burr hole and durotomy follows. Stealth Biopsy kit is assembled and the procedure is conducted with the designated biopsy needle set at a predetermined length based on prior calculations during stealth guided surgical planning. Three specimens of core tissue are usually collected and placed on formalin specimen bottle and sent off immediately to the histopathology lab with appropriate documentation. The durotomy site is covered with hemostatic surgicell while the burr hole site is plugged with bone wax. The mini-incision is closed with vicryl 3-0 sutures and wound dressed. Estimated blood loss is usually less than 5 mls. IV Rocephin is administered at induction of anesthesia at a dose calculated from the body weight of the child.
A three year old female referred from a General Hospital on account of one month history of progressive weakness of right upper and lower limbs, more pronounced in the upper limbs but still able to walk though with some difficulty due to imbalance. There is a deviation of the head to the left side which is worsened by attempted gaze towards the left side.
Neurological examination revealed a fully conscious child with normal pupils. Cranial nerve VI palsy was noted on the left side causing her to turn the neck to the left side to focus on any object on that side. The rest of the cranial nerves were essentially normal. Power on most muscle groups on the left upper and lower limbs were MRC 4/5 but full power on the right.
MRI Brain revealed a 2 cm diameter cystic lesion on the left CP angle with low signal on T1 but high signal on T2 and Flair and displaying fairly regular ring enhancement and causing mass effect on the ponto-medullary region of the brain stem on the left side but no associated hydrocephalus (Figure 1). Following multiple differential diagnosis including GBM, Brain abscess, TB, the basis for the referral for Stealth guided biopsy was made by the referral institution.
She successfully underwent a Transcerebellar Stealth Guided biopsy (Figure 2) of this lesion using the technical nuances outlined above. There were no associated complications. Check CT scan (Figure-3b) confirmed biopsy trajectory and no post op hematoma complications. Despite the plethora of differentials as outlined above, Histology report confirmed choroid plexus papilloma(Figure 4). He is presently on both oncology and surgical follow up for more than one year with a stable neurology.
11 years male with insidious onset, progressive and rather persistent headache for three years prior to presentation. There was associated right hemiparesis, progressive imbalance and difficulty with mobility. He was having increasing swallowing dificulty and also profound dyspnoea worsened by any exertion. Progressive difficulty with speech articulation has worsened in the last few months. He had voracious appetite and virtually feeds ad libitum and had become morbidly obese on presentation.
Examination on presentation revealed respiratory distress evidenced by flaring of alar nasi, orthopnoea, respiratory rate of 26/min. He was fully conscious, but incordinated movements and imbalance requiring support at all times. Pupils were normal and reactive. No visual field defects but bilateral impairment of abducent nerves was present. The uvula was found to be slightly deviated to the right side but with profound limitation of movements of the whole soft palate signifying cranial nerve IX . There was also impared movements of the vocal cords on indirect laryngoscopy signifying cranial nerve X palsy
MRI brain(Fig 5) revealed on T1 a diffuse expansion of the brain stem especially the pons with an intrinsic mass which takes up contract inhomogenously. It brightens up on T2 and Flair sequences to heighten the suspicion of a Diffuse Intrinsic Pontine Lesion (DIPG).
A clinical and radiological suspision of DIPG was already made at the referral hospital before but further oncology treatments required histological confirmation. Following adequate counselling of parents and consent procedeures, he was scheduled and successfully underwent Stealth Guided Transcerebellar Biopsy of Brain Stem Lesion as detailed in the techical section above. It is instructive to note that although the procedure was essentially uneventful, post op extubation was difficult due to already existing respiratory challenges. He was however gradually stepped down to tracheostomy and subsequently discharged with it and carried it all through period of adjuvant treatments.
Histology report confirmed Anaplastic Astrocytoma which necessitated Oncology referral where he completed adjuvant treatments including chemotherapy and radiotherapy. He was reviewed again 12 months post
discharge and was found to be morbidly obese due to voracious appetite. Despite the trachestomy tube still in place he was found to be having increasing respiratory difficulty. Unfortunately he pased on approximately 18 months from presentation
Brain stem tumors constitute about 10%–20% of all pediatric brain tumors [3]. They are extremely rare in adults. Diffuse Intrinsic Pontine Gliomas (DIPG) have been reported as the most common with a high mortality as less than 10% of afflicted children are alive at 2 years4. From this background of seemingly hopeless prognosis, emerges a controversy over the appropriateness of any invasive diagnostic biopsy procedures especially since Albright posited that relevant MRI sequence was just about enough diagnostic procedure to appropriate adjuvant treatments. Furthermore, based on conclusions from previous studies, the risk profile of brain stem stereotactic biopsy procedures were transient morbidity (28%), permanent morbidity (9%) [5], while mortality rate was up to 4%, they comprise approximately 10%–20% of all pediatric brain tumors [3]. Consequent upon this, tissue sampling was rarely performed. Recently the desire for definitive histology and molecular characterization seems to have reawakened the drive towards diagnostic biopsy procedures. It is instructive to note that these molecular biology analyses have unraveled a unique genetic makeup of DIPGs that is quite distinct from other pediatric high-grade gliomas or adult high-grade gliomas [6]. The major issues to content with were the attendant complications brain stem biopsy surgical procedures which is being addressed by adopting the minimally invasive stereotactic options. This is corroborated by a meta-analysis of 735 patients which confirms that stereotactic biopsy is a safe diagnostic procedure, associated with a low rate of procedure-related complications (overall morbidity 6.7%, permanent morbidity 0.6%, mortality 0.6%) 2. Furthermore, it allows adequate tissue sampling in 96.1% of cases, which is a prerequisite for histological diagnosis as well as for the molecular characterization of these tumors 2.
For both cases on this report, stealth guided biopsy was successfully conducted via a transcerebellar route. Although the preferable biopsy policy- transcerebral or transcerebellar, frame-based or frameless navigation is still debatable, adherence to the basic principle of neuronavigation is key and this is clearly outlined above. Frame-based stereotactic biopsy was previously regarded as standard procedure but with the advance of software and image quality, the application of frameless navigation system eg Stealth, is increasing [7]. It is important to report that frameless Stealth system was used in this series and contrasted CT was used for establishment of imaging coordinates in both cases, although other imaging modalities have been used including MRI, PET, SPECT [8]. Molecular characterization was not the primary focus, but tissue diagnosis facilitated evidenced based oncology referral. The child with anaplastic astrocytoma thus had complement adjuvant treatments including radiotherapy and chemotherapy. But unfortunately, disease progressed until demise 18 months later.
One of the cases was confirmed choroid plexus papilloma. CPP is commonly seen in the lateral and third ventricle, but rare form has been identified extending to the Cerebella-Pontine angle close to the opening of the fourth ventricle. CPPs comprise about 1% of intracranial neoplasms but 2-4% in children. Rare locations have been reported and include the third ventricle, cerebellopontine (CP) angle, and cerebral parenchyma [9]. It is instructive to note that no further treatments have been advised following oncology referral of the case due to the very benign nature of this lesion.
Conclusion- Stereotactic biopsy of pediatric brain stem lesions is safe procedure but requires meticulous planning and execution. In both cases presented here tissue sampling was accurate and facilitated targeted oncology referral and individualized treatment. It is worthwhile and advisable to refer such cases timely to centers with such capacity
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
